Facing the end with grace

Before she began guiding patients through their final stages of life, Ann Broderick followed a fascinating (and global) path to the University of Iowa Hospitals and Clinics.

By Lauren Sieben

Ann Broderick is a woman who loves her job, despite one aspect that troubles her: the recurring misunderstanding of her work as a palliative and hospice care provider.

Ann Broderick at the Java House in downtown Iowa City (Photo: Lauren Sieben)

“My job has never been to pull plugs, and it never will be to pull plugs,” Broderick said.

Broderick is an associate professor at the University of Iowa and the director of palliative care at the University of Iowa Hospitals and Clinics.

The World Health Organization defines palliative care as relief for the pain and symptoms of disease, but it is a treatment that “intends neither to hasten or postpone death.”

“We physicians assume that our role is to prevent death; my point is that our role is to prevent premature death,” Broderick said. “Our role isn’t to prevent this physiologic event from happening in every single person.”

A global upbringing

Broderick’s path to palliative care – and to Iowa – was far from linear. Between the time she was born in New Hampshire and the year she left for college at Princeton University, Broderick spent most of her childhood apart from her East-coast roots.

At age 7 she moved to Ghana during her father’s tenure in the Peace Corps. In Africa she developed an unusually keen understanding of international issues for a child.

When Broderick was 9 years old, the family returned stateside to Appleton, Wisconsin, moving every two years for her father’s job. The constant movement left Broderick feeling “a little bit like I was an army brat.”

During and after college, Broderick spent time teaching English in Bogotá, Colombia. She planned to become a K-12 Spanish teacher, but when she faced a dismal job market in the early 1980s, Broderick enrolled in math and science classes. She hoped to market herself as a bilingual teacher in a more specialized field.

”Lo and behold, I got an A in organic chemistry,” she said. “That was a quick moment where I thought ‘Maybe I can go to medical school.’ ”

Iowa City roots

When it came time to consider medical schools, Iowa was a natural first choice.

Broderick’s parents met in Iowa City – her mother’s hometown – and her grandfather was a former researcher and faculty member at the university medical school before he died in a traffic accident in the 1930s.

“It felt natural to come back to Iowa and pick up that legacy,” Broderick said. “It was a professional career that was at its peak and it was really quite a tragic death.”

Her interest in palliative care developed gradually, due in part to her volunteer work at Iowa City Hospice, and also to her father’s death. He was diagnosed with bone marrow cancer in Broderick’s fourth year as a medical student.

“For my father, dying at the age of 69 was desperately premature,” she said. “He still took great pleasure in reading the newspaper and staying up to date with politics and watching the world unfold, as well as watching his family unfold.”

In his 60s, Broderick’s father had also recently graduated from law school. At that stage in life he was unprepared to face death, and he died without receiving hospice services.

“Did that prompt me to do this? Probably,” Broderick said. “Probably the sense that there was an unmet need for my father.

“[My mother], I think, had a sense of shame about her impatience with him, because his care was so exhausting. In retrospect I wish she could have been there as his loving wife, which she was, and not as the person doing personal cares.”

Hospice: “Not doom and gloom”

Hospice is a support network for patients and their families: nurses, spiritual chaplains and social workers work together to address physical symptoms of disease along with spiritual and psychological effects of grief.

Though her father wasn’t able to receive hospice care, Broderick has been able to guide numerous other families through the process.

Along with teaching medical students and residents, Broderick also co-teaches an undergraduate course in the rhetoric department with lecturer Patrick Dolan. The course combines a volunteer commitment at Iowa City Hospice with an in-class reading-and-writing component.

Glen Cox has known Broderick since around 2000, when he began driving his parents to their medical appointments. His father died in 2005, and his mother, at 84, continues to face a multitude of ailments.

“Dr. Broderick was spot on as far as what she wanted to see happen to my parents,” Cox said. “She always took into consideration what their wishes were. She didn’t want to prescribe treatments or medications that would put them through an ordeal they didn’t really need to go through.”

And for Broderick, the patient’s wishes are the core of palliative care. Hospice centers are legally barred from recruiting patients – anyone who receives palliative care seeks it voluntarily.

“We shouldn’t mystify death by saying everybody needs to have time in an [Intensive Care Unit] or have a hospitalized component to their death,” Broderick said. “They might elect not to. And some do … When we arrive we’re not doom and gloom; we’re helping people make decisions.”